锁骨钩钢板治疗不稳定性锁骨远端骨折并发应力骨折的研究

Research on the stress fractures after hook plate fixation for unstable distal clavicle fractures

目的 研究应用锁骨钩钢板治疗锁骨远端骨折时应力骨折的发生原因及适宜的治疗方法。方法 自2003年5月-2005年9月，应用锁骨钩钢板治疗CraigⅡ、Ⅴ型锁骨远端骨折患者12例，手术遵循操作手册进行，对于喙锁韧带断裂者不予修补；骨折愈合后将钢板取出并对肩关节功能进行评分。结果 12例患者平均随访1年，其中10例顺利愈合，平均于术后1年取出内固定物，肩关节功能按照UCLA评分平均为33分，按照Constant评分平均为89分。另有2例患者在术后早期出现位于钢板内侧部位的应力骨折，经非手术治疗后骨折顺利愈合，肩关节功能良好。结论 锁骨钩钢板是治疗锁骨远端骨折的有效固定方法之一，但有时肩关节活动时会造成锁骨内侧应力集中，导致应力骨折，故应谨慎使用并严格指导和监督患者的术后康复锻炼。对于并发应力骨折的患者，非手术治疗可获得满意的结果。

Objective To investigate the causes of stress fractures after hook plate fixation for unstable distal clavicle fractures. Methods From May 2003 to September 2005, we admitted 12 patients who were stabilized with hook plates for unstable distal clavicle fractures of Craig types Ⅱand Ⅴ. The plates were removed after bone healing and the shoulder functions were evaluated by University of California-Los Angeles scoring system （UCLA） and Constant score system. Results The average follow-ups of 1 year revealed satisfactory healing in 10 patients. The mean UCLA score was 33 and mean Constant score 89. The average time for implant removal was 1 year after operation. Two patients suffered stress fractures on the medial side of the hook plate early after operation. Both were treated non-operatively and good functions of shoulder were obtained in the end. Conclusions To treat unstable distal clavicle fractures with hook plates, a surgeon must be aware that stress complications are not uncommon. Post-operative rehabilitation program should be under strict supervision because the plate may limit the micro movement of AC （acromioclavicular） joint and the stress will increase on the medial side of the plate.